Frequently Asked Questions

1. Q. Is the Group Reimbursement Welfare Plan a primary medical insurance plan?

A. It is a tertiary Plan and payer of last resort. This means that if you have any other source of payment, this Plan will pay the difference, if any, between the maximum amount payable from the other coverage source and the amount of the healthcare service provider’s bill up to the maximum amount of benefits as described in your Group Reimbursement Welfare Plan booklet.

For example, if your spouse works and is covered at his or her employment by any benefit plan, reimbursement or insurance that would also cover you and your Dependents, you must first seek payment for your own and your Dependents’ claims from that source. That is what having another source of payment for benefits means. Other sources of benefits include a lawsuit against the person or party who injured you or your Dependent, as well as governmental programs. You are first required to make application for benefits or payment under any such plan or source other than this Plan, including a situation where potential litigation may result in recovery.

2. Q. I have not received my medical card, why?

A. To receive a medical card you must enroll in the health care program by completing a Welfare Funds of Local 464A Eligibility Enrollment Form. This form is sent to each employee when he/she is hired or re-hired. Click Forms for a copy that you can print. There is generally a 6 or 9 month waiting period before benefits go into effect. The medical card will not be received until your benefits become effective.

3. Q. Who do I call if I have a question about my medical benefits?

A. Consult your Group Reimbursement Welfare Plan booklet. If you still have a question call Maxon at 1.800.999.3309. This is the Member Service telephone number on your Horizon Blue Cross Blue Shield medical card.

4. Q. What if I have a question about a medical bill?

A. Call Maxon at 1.800.999.3309. This is the Member Service telephone number on your Horizon Blue Cross Blue Shield medical card.

5. Q. I have received a medical benefit denial and I need an explanation; where do I call?

A. Call Maxon at 1.800.999.3309. This is the Member Service telephone number on your Horizon Blue Cross Blue Shield medical card.

6. Q. How can I find the medical, dental or vision care center closest to me?

A. See your Group Reimbursement Welfare Plan booklet or click here.

7. Q. I am a part-time employee; can I add my dependents (wife, children) to my medical coverage?

A. You must be a fulltime employee to include your eligible dependents under the welfare programs.

8. Q. I have my own medical provider who is not associated with any of the Local 464A medical centers. Is that permitted?

A. Yes, you can use any covered medical provider you wish. For a list of providers who are part of the in-network group of physicians call toll free 800.810.2583 or go to www.horizonblue.com.

9. Q. If I go to www.horizonblue.com what steps should I follow to find an in-network provider?

A. Follow these six steps carefully:
1. At the Horizonblue Home Page select the 'tab' that states 'MEMBERS/INDIVIDUALS' and then select 'NATIONAL ACCOUNTS' which is listed on the left side of the Webpage. A new Webpage will open.
2. Scroll down and select "PROVIDER DIRECTORY' which is listed on the right side of the page. A new Webpage will open.
3. Select 'HORIZON TRADITIONAL INDEMNITY' a new Webpage will open called 'BLUECARD DOCTOR AND HOSPITAL FINDER' .
4. As a member (not a guest) in the box titled 'IDENTIFICATION PREFIX' type in 'HFW' and select continue. A new Webpage will open.
5. Type in your zip code and select the distance you would be willing to travel (5 miles, 10 miles, 25 miles etc.) and select continue.
6. On the next Webpage select the specialty desired and then select continue. The next Webpage will list in-network providers, their locations and telephone numbers where you may call to make an appointment.

10. Q. But what if I prefer a medical provider who is not in-network?

A. If you use a covered medical provider who is out of network your claims will be processed according to the Plan and may be subject to a yearly deduction. Be sure to fully understand the medical coverage applicable to you. If you have questions contact Maxon at 1.800.999.3309. Always be sure to present your medical card to your provider whether in-network or out of network.

11. Q. I prefer to use a dentist outside of Local 464A’s list of dental centers. Is this permitted?

A. If you use a dentist outside of Local 464A’s dental centers any intended basic or major dental procedure expected to cost $200.00 or more must be approved in advance via a pre-authorization form. Have your dentist submit the pre-authorization form to the Little Falls office, attention Dental Department. Reimbursements will be made pursuant to the reimbursement schedule contained in the Plan document.

12. Q. When does the medical, dental and vision care coverage end for my children?

A. Coverage for children ends when they have reached age 19. If a child is attending an accredited four (4) year college (for an academic degree) on a full-time basis, coverage under the Plan remains in effect until he/she leaves school or reaches age 23 whichever comes first. To maintain coverage for full-time students between age 19 and 23 a letter must be sent to the attention of the Benefits Department at the Little Falls, NJ office prior to the start of each semester (fall and spring) stating that the child is a full-time student.

13. Q. What is my annual prescription drug benefit?

A. For specific details see your Group Reimbursement Welfare Plan booklet. The dollar limit indicated refers to the total cost of the drugs billed, not to a tally of your co-payments

14. Q. Can I use the UFCW Local 464A Prescription Drug (Express Scripts) card if I have prescription drug coverage under another plan?

A. The UFCW Local 464A prescription program is a secondary plan. This means that if you are covered under any other insurance plan, you must first use the prescription drug benefit from that other plan

15. Q. What if the other prescription plan doesn’t cover the full cost of the prescription, how do I apply for reimbursement of my prescription bills?

A. Prepare a UFCW Local 464A Welfare Fund Prescription Claim Form, attach a copy of your prescription receipt(s) and the Explanation of Benefit (EOB) from your other insurance carrier and send all to the Prescription Department at the Local 464A Little Falls, NJ headquarters. Your claim will be reviewed and properly processed by Express Scripts

16. Q. Where can I obtain this form?

A. Click on Forms on this site or call the Local 464A Prescription Department in Little Falls, NJ at 973.256.5803

17. Q. How much do I have to pay for prescriptions when I use my Local 464A Express Scripts Prescription Card at my pharmacy?

A. Your co-payment is $2.00 for a generic and $5.00 for a brand name drug

18. Q. I just noticed that I am paying more for my prescriptions, why?

A. This may be because you have reached your prescription allowance annual maximum. See your Group Reimbursement Welfare Plan booklet for prescription coverage.

19. Q. But I must have my prescriptions, is there anything I can do?

A. In certain instances if the condition being treated with the prescription is life threatening, an extension may be provided. This applies only to fulltime employees and requires a letter from the treating physician clearly stating that the condition being treated is life threatening. This letter must be prepared by the treating physician on his/her official stationary (letterhead), state the diagnosis, and be addressed to the Board of Trustees C/O the Little Falls, NJ office.

20. Q. Do extensions of Prescription Drug Coverage because of a life threatening illness apply to my whole family?

A. As reported in the September 2007 issue of the Sentinel, the extension of Prescription Drug Coverage because of a life-threatening illness only applies to the member or dependent diagnosed with a life-threatening illness, and not the entire family. In effect, this means that members or dependents who have not been so diagnosed, will not be provided extended Prescription Drug coverage.

21. Q. Are there limits on the supply I can obtain with each prescription?

A. Yes. Covered prescriptions are limited to a maximum 34-day supply

22. Q. Where can I get my prescriptions filled?

A. Following is a short list of participating pharmacies. However, most local area pharmacies participate in this program:

23. Q. What if I need an emergency prescription when I am out of town?

A. You may use your UFCW Local 464A Express Scripts Card at pharmacies nationwide

24. Q. Are there medications that are not covered under the Prescription Plan?

A. Yes. Over-the-counter items are not covered. Other items specifically excluded are oral contraceptives, fertility medications, allergy serums, vaccinations, injectable medications and therapeutic devices

25. Q. Does the Prescription Plan cover smoking cessation products?

A. Only prescription smoking cessation products are covered

26. Q. What should I do if I lose or damage my Local 464A Express Scripts Prescription card?

A. Contact the Prescription Department at 973.256.5803 for a replacement card

27. Q. Can I get vision care anywhere I want?

A. The vision care benefit provided by Local 464A is available only at authorized vision care centers. See your Group Reimbursement Welfare Plan booklet or click here for a list of the centers.

28. Q. Are contact lenses and sunglasses included under the vision care plan?

A. Regular and disposable contact lenses are provided. Sunglasses can be secured at reduced rates. See your Group Reimbursement Welfare Plan booklet for details.

29. Q. What is COBRA?

A. COBRA stands for the Consolidated Omnibus Budget Reconciliation Act of 1985. It is a federal law that allows for the continuation of healthcare plan coverage that would otherwise end because of a “qualifying event”. See your Group Reimbursement Welfare Plan booklet for details

30. Q. What is a “Qualifying Event”?

A. A “qualifying event” is either one of the following occurrences:
1. Your hours of employment are reduced; or
2. Your employment ends for any reason other than your gross misconduct

A. Generally, you are required to pay the entire cost of continuation coverage. The amount you may be required to pay may not exceed 102% (or, in the case of an extension of continuation coverage due to a disability as determined in writing by the Social Security Administration, 150%) of the cost to the group health plan (including both employer and employee contributions) for coverage of similarly situated plan participants or beneficiaries who are not receiving continuation coverage

A. Contact the Plan Administrator at the Little Falls, NJ offices, 973.256.6790

33. Q. How long will my COBRA continuation coverage last?

A. In the case of loss of coverage due to the end of employment or reduction in hours of employment, COBRA coverage generally may be continued for up to a total of 18 months. An additional 11-month extension may be available if you are determined by the Social Security Administration (SSA) to be disabled. See your Group Reimbursement Welfare Plan booklet for details

34. Q. Under the Pension Plan what does years of vesting mean?

A. A vesting period is the amount of time a person holding a right must wait until they are capable of fully exercising that right and until that right may not be taken away. Your years of vesting service are used by the pension plan to measure whether or not you are eligible for any of the various types of pension benefits. For example, you must have at least five years of vesting service to be eligible for any types of pension benefits available under the pension plan. Your right to a normal or early retirement pension is non-forfeitable once you have earned five years of vesting service.

35. Q. I will be retiring soon. How do I arrange for my pension payments to start?

A. Be sure to notify the Pension Department in Little Falls, NJ well in advance of your expected retirement date. You will be provided with the appropriate forms, which must be filled out and returned in advance to ensure that pension payments commence on time.

36. Q. Can I have my pension payments directly deposited into my checking account electronically?

A. Yes. Contact the Pension Department in the Little Falls office. You will need to provide your checking account number and the routing number of your bank. If you are unsure of the correct numbers to provide contact your bank.

37. Q. Can I borrow money in advance from the pension I expect to receive when I retire?

A. No. The Plan is a Defined Benefit Plan, not a Defined Contribution Plan. As a Defined Benefit Plan, no individual participant account balances are maintained under the Fund. Participants are not permitted to make withdrawals from nor contributions to the Fund.

38. Q. Does the Pension Plan offer a lump sum payment program?

A. Pensions are payable monthly. However, if the actuarial value of any new pension payable under the Plan is $5,000 or less, the trustees may elect to pay it in one lump sum.

39. Q. What happens to my pension if I die?

A. If you are a participant in the Local 464A Pension Plan your legal spouse to whom you have been married for at least one full year prior to your death or retirement (whichever comes first), would be entitled to 50% of your calculated monthly benefit for life.

If you are a participant in the National Pension Fund the spousal benefit may be elective at the time of your retirement.

A&P part time members should contact the A&P main office for information on their entitlements.
In all instances your benefit cannot be assigned to any other person.

40. Q. Where are the UFCW Local 464A offices?

A. They are as follows: